Panel Tackles Solutions to Painkiller Epidemic

Has our level of pain gone up 400% in a decade? No, says Dr. David Frenz, but our use of pain killers has. Frenz, Vice President and Executive Medical Director of Mental Health and Ambulatory Services at North Memorial Health Care, told health and law enforcement professionals in October that Americans absolutely love their drugs. He spoke as part of a panel discussion on solutions to the local painkiller epidemic.

The four experts agreed prevention is a key to moving forward. “We are not going to arrest our way out of these issues,” said Captain Andy Smith from the Hennepin County Sherriff’s office. While the epidemic is not unique to Minnesota, the quality of our heroin, which Smith called among the purest in the country, makes it a cheaper alternative to prescription opioids, which are narcotic painkillers.

In 2000, 23 Minnesotans died of opioid related drug overdoses. Last year that number rose to 216, with more than half of the drug-related deaths tied to prescription medications rather than illegal street drugs, according to the Minnesota Department of Health. Most heroin deaths started as pain pill addictions, Smith said.

Frenz attributes the rise in use to the emphasis on treating pain, along with the introduction in the ‘90s of long acting pain medications like OxyContin. As far as alternative prescriptions, there are not many effective options, according to Frenz. There is a gap between ibuprofen and opioids without great alternatives, he said. He said he would like to see more doctors and patients enter into an opium agreement.

And even opioids may not be an effective treatment for long-term pain, according to Dr. Rohaan Mehta, a pain management physician with the North Memorial Comprehensive Pain Management Center. He cautioned the prescribers attending the discussion, “Don’t continue to prescribe if the treatment goals are not being met. If the patient started out with an 8 out of 10 (level of) pain, and six months later with escalating opioids, they are still 8 out of 10, maybe we should think about opioids not serving their function here. Maybe tapering is wise.”

Mehta offered the health care professionals alternatives to prescribing opioids, such as physical therapy, acupuncture, bracing or even surgery. He calls the point of initiating opioid use the most critical in solving the opioid epidemic. “Let’s make sure that the right people get opioids for the right reasons.”

An online database can assist pharmacists and medical professionals when determining if a patient should be prescribed controlled substances. It is used in every state but Missouri and allows physicians and other prescribers to check if a patient may be abusing pain medications, such as obtaining them from more than one provider. Its intent, explained Katrina Howard, with the Minnesota Prescription Monitoring Program (PMP), is to be a source of information for prescribers and pharmacists, and a tool for law enforcement and medical examiners.

The program is only effective if health care professionals use it. “If you don’t check the PMP every time you refill or write opioid prescriptions, you might be missing very important information,” Mehta cautioned.

Howard agrees. “Be an informed dispenser or provider prior to providing patients with controlled substances,” she told the attendees.

And for patients already addicted to opioid medicine, he would like to see the stigma removed from obtaining treatment. Minnesota has tremendous treatment options, he explained, including medications like Methadone and Suboxone, which reduce the use of opioids and keep patients engaged in addiction treatment.

Not all opioid users are patients using medicine prescribed for a specific condition. Some users are children who find pills in their parents’ homes and some are individuals self-treating a new condition with an old, unused bottle, Frenz said.

Unused medicine can be safely disposed in designated drop boxes, Smith said. Locally, those boxes are at the Osseo, Maple Grove and Golden Valley Police Departments. In addition, this year it became legal for Minnesota pharmacies to take-back and dispose of unused medicine.

Prevention is key, the experts agreed, and that starts with the health care provider prescribing, “the right medication for the right circumstance for the right duration,” Frenz told the audience.

The panel discussion was sponsored by Partnership for Change and North Memorial Health Center.